America can’t afford its sleep problem

America, we have a problem. It’s weighing on the economy, our quality of life, and our ability to thrive at work. And no, it’s not just the COVID-19 pandemic.

A recent analysis by Rand Quarterly suggests that Americans aren’t sleeping well, and the economic impact is huge. In the U.S. alone, the cost of insufficient sleep is as high as $411 billion per year, or 2.28% of GDP.

These projections are alarming, considering 70 million Americans suffer from sleep disorders. Yet many employers still don’t see the immediate correlation between their bottom lines and clocking in less than 6 hours per night on a regular basis. This may be due to the gradual accumulation of the adverse consequences of poor sleep are incremental, which are not always obvious. In addition, lifestyle factors — such as obesity, tobacco use — and the presence of one or more social determinants of health (SDOH) also contribute to poor work performance and economic loss. Only in a few industries, like transportation or sports (where sleep disorders are notorious) is the correlation between sleep and performance clear.

Related: Quality sleep: Why employers must support this pillar of a ‘new normal’

But employers cannot afford to cover just the bare minimum in sleep treatment costs. No longer is a referral to a sleep lab for a single night of in-person analysis (the polysomnography) sufficient. America, we can and must do more.

Sleep loss, by the numbers

A 2015 study published by the Journal of Occupational Environmental Medicine, which focused exclusively on individual productivity and health care expenditures, found that individuals who reported sleep trouble (e.g., higher levels of sleep disturbances) tended to have lower work performance ratings and higher levels of absenteeism. They also carried higher health care costs: approximately $3,400 to $5,200 additional dollars spent per person on health care for individuals who reported sleep problems. After all, untreated sleep disorders increase the risk for comorbid medical problems, such as heart disease, diabetes, and depression — including hospitalizations associated with decompensation of these conditions.

Because sleep disorders are often chronic in nature, there is no quick-fix sleep treatment that will yield optimal results and cost savings. Many individuals require ongoing support and follow-up, including management of CPAP (continuous positive airway pressure) machines, mental health therapy, and/or medications. Many, if not most, individuals will also need to major lifestyle modifications to improve sleep, such as changing their diet and sleep patterns, which are hard to sustain.

Therefore, investing $5,000 for an individual to undergo an in-person sleep study, with few resources for that individual to address sleep problems in an ongoing manner after a sleep study is obtained, may not lead to optimal outcomes. If boosting economic productivity and eliminating poor performance and absenteeism are key outcomes, we need to do more. Specifically, we need to expand access to holistic, high-quality, affordable, and effective sleep care.

We stand to gain huge economic benefits by doing this for America’s workforce.

Broadening sleep care, reining in costs

Emerging case studies demonstrate that expanding sleep health benefits can pay dividends down the line. There are several ways to go about this, but all organizations that expand sleep health benefits tend to have a few things in common:

• They rely on advanced, yet accessible, screening programs for at-risk individuals;
• They use communications technology (e.g, telehealth) to bridge the gaps between sleep specialists and patients;
• They support accessible treatments and solutions by all workers, regardless of where they live and work.

Atlanta-based electric utilities provider Southern Company saw dramatic cost savings and clinical outcomes improvement when it leveraged an organization-wide initiative to improve sleep health. By screening 4,000 at-risk workers for sleep apnea, 1,500 ended up being treated for sleep disorders. Southern estimated that this initiative alone saved $1.2 million in one calendar year by reducing the need for medical services for conditions such as heart disease, which are complicated by sleep apnea.

Other organizations saw similar cost savings by putting more emphasis on using sophisticated screening and communications technology.

A 5-year private-public partnership between Redwood Pulmonary Medical Associates, a private sleep medicine practice, and the Health Plan of San Mateo (HPSM), saw $1,132,510 — or approximately 52% in cost savings — by combining the use of advanced technologies with comprehensive care and education. Individuals either at risk for or experiencing symptoms of sleep apnea had comprehensive sleep evaluations in conjunction with cardiopulmonary sleep testing. Sleep specialists could access physiologic data remotely, analyze this information, and recommend next steps. Those who required treatment for sleep apnea were offered ongoing telehealth or in-person sleep consultations, further testing, follow-up care, and remote monitoring of CPAP compliance.

A powerful testament to the impact of improving sleep health is in the area of professional and collegiate sports. A Stanford study of men’s basketball players who extended their sleep to 10 hours per night found that these players ran faster in both half-court and full-court sprints. Also, their shooting improved by 9% for both free throws and three-point shots.

If athletes can demonstrate improved performance, it is possible that the rest of us can benefit from more sleep. By offering our workforce smarter, quantitative, and long-term sleep-health solutions, organizations aren’t just putting a bandage on an open wound. They are demonstrating their commitment to a well-rested workforce, as well as a healthier bottom line.

As organizations face tighter budgets but escalating health needs of their workers, sleep health is one of the smarter areas to target. Exploring ways to expand awareness, screening (such as through the use of advanced wearable sleep trackers, paired with high-quality reports and remote access to specialists), and treatments (through ongoing care/interactions with sleep specialists) will reap huge rewards beyond 2022).

Dr. Melissa Lim is the co-founder and chief medical officer of Somnology and the medical director of Redwood Pulmonary Medical Associates. Patrick Yam is the co-founder and CEO of Somnology.